Alcoholic ketoacidosis: confused diagnosis

A woman in her 30s presented with a 3-day history of nausea, vomiting and abdominal pain. She was found to be in ketoacidosis with an elevated serum glucose level of 18.2 mmol/L (328 mg/dL). Based on her initial presentation and test results, she was believed to have new onset diabetic ketoacidosis (DKA) from previously undiagnosed diabetes. Subsequently, she was found to have acidosis caused by acute or chronic alcohol consumption, even though her serum glucose was higher than would be typically expected with alcohol abuse. Alcoholic ketoacidosis usually has lower glucose levels as well as retained mental function when compared with DKA. A haemoglobin A1c, fructosamine level, betahydroxybutyrate to acetoacetate ratio, C-peptide and antibodies to pancreatic beta-cells can help rule out diabetes as the aetiology of the ketoacidosis. This patient was treated with fluids and electrolyte replacement, showed rapid improvement, received alcohol cessation resources and was discharged home.